Healthcare Provider Details

I. General information

NPI: 1225687692
Provider Name (Legal Business Name): JULIANNE FANNY AVRUTIK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 RIDGE RD STE 5
DAYTON NJ
08810-1398
US

IV. Provider business mailing address

22 ELEANOR DR
KENDALL PARK NJ
08824-1816
US

V. Phone/Fax

Practice location:
  • Phone: 732-274-2544
  • Fax:
Mailing address:
  • Phone: 908-812-5633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02733100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: